Impact of liposomal bupivacaine transversus abdominis plane blocks on patient outcomes in minimally invasive colorectal surgery

  • Letisha Mirembe Texas Tech University of Health Sciences
  • Elwin Rutayomba
  • Jankikeerthika Dharmarpandi
  • Brandon Wei
  • Emmanuel Eguare Jr.
  • Esha Singhal
  • Izi Obokhare

Abstract

Background and Objectives: As part of enhanced recovery after surgery protocols, there has been an increased interest in improving analgesic techniques. This study compares the efficacy of liposomal bupivacaine transverse abdominis plane blocks on outcomes in colorectal surgery patients.

Methods: This retrospective study compared patients who had minimally invasive colorectal surgery and perioperative liposomal bupivacaine blocks with patients who did not receive this block on post-operative outcomes, including lengths of stay, opioid consumption, and postoperative pain scores.

Results: The mean length of stay in the control group was 4.79 days; in the liposomal bupivacaine group, it was 4.14 days (p = 0.011). There were no differences in opioid use, acetaminophen use, or pain scores in these 2 cohorts. There was a decrease in NSAID use in the liposomal bupivacaine group.Conclusion: This study shows that liposomal bupivacaine blocks can improve some postoperative outcomes in minimally invasive colorectal surgery patients, especially by decreasing length of stay and possibly by decreasing use of other analgesics.

Keywords: Minimally invasive surgical procedures; analgesics, nerve block; post-operative pain management; bupivacaine

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References

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1. Hughes MJ, Ventham NT, McNally S, Harrison E, Wigmore S. Analgesia After Open Abdominal Surgery in the Setting of Enhanced Recovery Surgery: A Systematic Review and Meta-analysis. JAMA Surg. 2014/12/01/ 2014;149(12):1224. doi:10.1001/jamasurg.2014.210
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3. Sjövall S, Kokki M, Kokki H. Laparoscopic Surgery: A Narrative Review of Pharmacotherapy in Pain Management. Drugs. 2015/11// 2015;75(16):1867-1889. doi:10.1007/s40265-015-0482-y
4. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011/04/11/ 2011;171(7):686-691. doi:10.1001/archinternmed.2011.117
5. Maxwell JC. The prescription drug epidemic in the United States: A perfect storm: The prescription drug epidemic in the USA. Drug and Alcohol Review. 2011/05// 2011;30(3):264-270. doi:10.1111/j.1465-3362.2011.00291.x
6. Alam A. Long-term Analgesic Use After Low-Risk Surgery: A Retrospective Cohort Study. Arch Intern Med. 2012/03/12/ 2012;172(5):425. doi:10.1001/archinternmed.2011.1827
7. Hooten WM, St Sauver JL, McGree ME, Jacobson DJ, Warner DO. Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based Study. Mayo Clin Proc. 2015/07// 2015;90:850-856. doi:10.1016/j.mayocp.2015.04.012
8. Rafi AN. Abdominal field block: a new approach via the lumbar triangle: Correspondence. Anaesthesia. 2001/10// 2001;56(10):1024-1026. doi:10.1111/j.1365-2044.2001.2279-40.x
9. Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. Mar-Apr 2012;37(2):193-209. doi:10.1097/AAP.0b013e3182429531
10. El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy †. British Journal of Anaesthesia. 2009/06// 2009;102(6):763-767. doi:10.1093/bja/aep067
11. Hain E, Maggiori L, Prost À la Denise J, Panis Y. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Colorectal Dis. Apr 2018;20(4):279-287. doi:10.1111/codi.14037
12. McDonnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008/01// 2008;106(1):186-191, table of contents. doi:10.1213/01.ane.0000290294.64090.f3
13. Peltrini R, Cantoni V, Green R, et al. Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol. 2020/08// 2020;24(8):787-802. doi:10.1007/s10151-020-02206-9
14. Hamid HKS, Marc-Hernández A, Saber AA. Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg. Mar 2021;406(2):273-282. doi:10.1007/s00423-020-01995-9
15. Liu X, Ou C, Peng F, Mu G. Comparison of analgesic efficacy of continuous transversus abdominis plane block with continuous epidural analgesia in patients undergoing abdominal surgery: a systematic review and meta-analysis. J Int Med Res. 2020/06// 2020;48(6):030006052092269. doi:10.1177/0300060520922691
16. Pirrera B, Alagna V, Lucchi A, et al. Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program. Surg Endosc. Jan 2018;32(1):376-382. doi:10.1007/s00464-017-5686-7
17. Cummings IIIK, Chahar. Liposomal bupivacaine: a review of a new bupivacaine formulation. JPR. 2012/08// 2012:257. doi:10.2147/JPR.S27894
18. Stokes AL, Adhikary SD, Quintili A, et al. Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery. Diseases of the Colon & Rectum. 2017/02// 2017;60(2):170-177. doi:10.1097/DCR.0000000000000747
19. Vyas KS, Rajendran S, Morrison SD, et al. Systematic Review of Liposomal Bupivacaine (Exparel) for Postoperative Analgesia. Plastic and Reconstructive Surgery. 2016/10// 2016;138(4):748e-756e. doi:10.1097/PRS.0000000000002547
20. Uskova A, O’Connor JE. Liposomal bupivacaine for regional anesthesia. Current Opinion in Anaesthesiology. 2015/10// 2015;28(5):593-597. doi:10.1097/ACO.0000000000000240
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Published
2024-07-16
How to Cite
Mirembe, L., Rutayomba, E., Dharmarpandi, J., Wei, B., Eguare, E., Singhal, E., & Obokhare, I. (2024). Impact of liposomal bupivacaine transversus abdominis plane blocks on patient outcomes in minimally invasive colorectal surgery. The Southwest Respiratory and Critical Care Chronicles, 12(52), 1-7. https://doi.org/10.12746/swrccc.v12i52.1295